With a long practice of organ transplantation, retransplantation has become a major goal in patients with long-term failure of their first transplant (chronic rejection, exhaustion of the transplant, recurrence of the initial disease, etc. ). In addition, retransplantation can be necessary in the initial period, due to severe acute rejection, a non-functioning organ, or surgical complication. Immunological and non-immunological factors affecting the success of a second transplant are described in this volume, together with alternatives to retransplantation. It is hoped that in the future retransplants will be less frequent, as a result of improved prevention of transplant failure. J. L. Torrroine et a/. (ens. ), Retra isplantation, xvii. Q 1997 Kluwer Academic Pirblislters. P . iilted in Great Britain. List of contributors R. ARNOLD Y. W. CHO University of Pittsburgh UCLA School of Medicine Center for Medical Ethics Tissue Typing Laboratory Division of General Internal Medicine 950 Veteran Avenue 200 Lothrop Street - MUH, Suite W-919 Los Angeles, CA 90095-1652 Pittsburgh, PA 15213-2582 USA USA P. COCHAT M. A. BELGER Hopital Edouard Herriot UKTSSA Pavillon S Fox Den Road 5, Place d'Arsonva1 Stoke Gifford F-69437 Lyon Cedex 3 Bristol BS12 5RR France UK B. CUZIN F. BERTHOUX Hopital Edouard Herriot Service de Nephrologie et Pavillon V Transplantation Renale 5, Place d3Arsonval Hopital Nord F-69437 Lyon Cedex 3 F-42055 Saint Etienne Cedex 2 France France J. H. DAUBER C.

During the past quarter century there has been a renaissance of interest in the use of peritoneal dialysis as the primary dialytic modality for the treatment of children with end-stage renal disease (ESRD). The development of continuous ambulatory peritoneal dialysis (APD) has facilitated the provision of prolonged dialysis to infants, children and adolescents and has provided pediatric nephrologists worldwide with a real opportunity to administer effective dialysis therapy to all patients afflicted with ESRD. It has been more than a decade since the initial publication of CAPD/CCPD in Children. In the interim, a great deal of clinical experience with patients receiving peritoneal dialysis has been accumulated and research efforts have substantially increased our understanding of the technique. Therefore, we felt that a second edition of CAPD/CCPD in Children was propitious to update the advances of the past decade.

Collected Papers from the Seventh International Symposium on Biochemical Aspects of Kidney Function, Bratislava, 9-12 April 1984

This Pediatric Nephrology series is a focus on salient points which at the time of each annual seminar are of importance to the practicing pediatrician and nephrologist, the clinical researcher, and basic researcher interested in clinical problems. Hence the format of selected papers and panel discussions to capture the tenor of the times. More thorough coverage of many of the subjects can be found in current journals and textbooks listed in the authors' references. Those searching for the conventional should look there rather than here since our aim is not to cover each subject in its entirety but to secure attention to the controversial aspects of the subjects, dispel the notion that there is one answer to a question, and raise the level of inclination toward dynamic problem solving. The basic subject chosen this year reflects dominant concerns this year and the participants chosen--speakers and discussants--represent certain views relevant to the subject at this time. To reflect the tempo and flavor produced by this unique blend, the discussions are included almost verbatim. For some this means readability; for others, excess verbiage. The careful reader will notice that I have been the chairman of all sessions and have moderated all discussions. This is in keeping with our aim to ferret out interrelated basic questions and varying answers to the subjects--seen as related in problems and solutions. In the discussions, all names have been deleted.

Having kidney failure is not a unique experience. Neither is receiving a kidney transplant or undergoing dialysis. Adopting to irreversible uremia - a devastating illness- by assisting others to cope with their own life trial represents the best of human traits. Bonded by marriage for 42 years, I was privileged to love and live with a marvelous and unique individual whose approach to life with this horrific disease taught me to regard every moment of our existence as precious. Preparation of this volume had two main objectives: 1) To honor the author for all of efforts in behalf of kidney patients. 2) To disseminate her insights and wisdom to those who may derive comfort and benefit from her words. Mildred (Barry) Friedman was a medical writer and patient advocate devoted to the American Association of Kidney Patients, who died at University Hospital of Brooklyn on September 21 st 1997 at the age of 61 of complications of type 1 diabetes. Barry, the second child of Leontine and Hardinge Barrett-Lennard, was born on October 17,1935 in Manhattan and attended Brooklyn College as a New York State Scholarship Awardee earning a Bachelor of Arts degree in 1953. She subsequently began teaching in the New York City elementary schools gaining a Master's degree in education. Following the birth of her third child, Barry developed both diabetes and Addison's disease forcing her retirement from teaching.

Written for fellows, practicing nephrologists, and internists who treat patients with disorders affecting the renal system, Comprehensive Clinical Nephrology, 7th Edition, offers a practical approach to this complex field, supported by underlying scientific facts and pathophysiology. World leaders in nephrology provide current information on clinical procedures and conditions, covering everything from fluid and electrolyte disorders to hypertension, diabetes, dialysis, transplantation, and more-all in a single, convenient volume. Provides a "just right" amount of basic science and practical clinical guidance to help you make efficient and informed decisions. Contains new chapters on Blood Pressure Management in the Dialysis Patient, Kidney Diseases Associated with Corona Viruses, Ultrasound Imaging in Nephrology, and Radiologic and Nuclear Imaging in Nephrology. Includes more than 1,500 full-color illustrations that highlight key topics and detail pathogenesis for a full range of kidney conditions and clinical management. Covers key topics such as COVID-19, chronic kidney disease, end stage kidney disease, kidney transplantation, glomerular disease, onco-nephrology, dialysis, and much more. Features popular, color-coded algorithms that provide easy access to important content: yellow boxes for general information, green boxes for therapeutic intervention, and blue boxes for necessary investigations. Includes quick-reference boxes with links to clinical guidelines in all relevant chapters, plus self-assessment questions online. An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud.

Glomerulonephritis is one of the commonest causes of end-stage renal failure worldwide. Although there have been considerable advances in the management of renal failure by dialysis and transplantation, there has been relatively little progress in its prevention. This volume sets out to review current practice in the treatment of glomerulonephritis, which is aimed both at controlling the clinical manifestations, e.g. nephrotic syndrome, and at preventing the progression to renal failure. The term glomerulonephritis covers a wide range of conditions with different immunological, histological and clinical features. This volume therefore starts with reviews of the immunology and pathology of different types of glomerulonephritis. This is followed by detailed consideration of the treatment of the commoner primary and secondary forms of the disease. There are separate chapters on special circumstances, such as glomerulonephritis in pregnancy or following renal transplantation. In each chapter, attempts are made to review the evidence for the effectiveness of treatment, based on controlled trials, immunopathological principles and the authors' considerable experience. Although some aspects of the treatment of glomerulonephritis can be found in the standard texts on renal disease, this volume provides an up-to-date, thoroughly referenced, and practical guide to management. As such, it should be of value to nephrologists and general physicians, including those in training, and to postgraduate students of nephrology.

The behavior of the kidney in normal pregnancy, as well as in complicated pregnancy, is a very interesting, but still in many ways an unknown topic in renal medicine. It is undoubtedly difficult to determine, even in normal women, the behavior of renal hemodynamics throughout gestation, since the fear of impairing a new life (i.e., the fetus's life) will limit, for ethical reasons, the use or the frequent repetition of diagnostic tests on the mother. On the other hand, the study of complicated pregnancy even for diagnostic purposes (for planning adequate treatment), except in a few countries that are known for the advanced health education of the population, has to face serious difficulties. First of all, pregnant women usually seek the help of an obstetrician when gestation is already in an advanced stage. This makes it difficult to determine when and how asymptomatic signs of any disease discovered during pregnancy have first occurred. A second difficulty is that frequently the patient does not know whether a given disease has preceded pregnancy. Pregnancy is a condition of young women, and a young woman frequently has never seen a physician; thus, no urine analysis or blood tests have been performed before the gestation. Not infrequently, even blood pressure has never been measured. This will make it difficult to classify hypertension discovered in late pregnancy as pregnancy-induced hypertension or as chronic hypertension in pregnancy.

IgA nephropathy has, in the course of two decades, become one of the most important renal diseases. Not only is it the most common form of glo merulonephritis seen in many countries, its increasing recognition by renal biopsy in this time has allowed sufficient study to conclude that it is also one of the most frequent causes of end-stage renal failure. The clinical features are diverse, and only in a minority do recurrent macroscopic hematuric episodes associated with an upper respiratory tract infection allow a confident clinical diagnosis. All clinicians, from community practitioners to general and specialist internists and surgeons, should be aware of its manifestations in patients of all ages. Its relationship with Henoch-Sch6nlein purpura is especially interesting. The discovery of IgA nephropathy has caused an explosion of interest and research. The disease itself (if indeed it can be regarded as a single entity rather than a syndrome) has been studied extensively by many groups and a synopsis is presented by several of the leaders in this clinical field. Parallel with the increased understanding of the renal disease, there has occurred similar incremental knowledge in such diverse fields as the structure and function of the glomerular mesangium, the biology of mucosal immu nity, and the IgA immune response. This book has collected essays on these topics that emphasize their importance in the rclation to the study of IgA nephropathy."

First principles chapter clearly explains the key concepts, processes and structures of the renal system. Clinical essentials chapter provides an overview of the symptoms and signs of renal disease, relevant history and examination techniques, investigations and management options. Disease-based chapters give concise descriptions of all major disorders, e.g. chronic kidney disease, each chapter introduced by engaging clinical cases that feature unique graphic narratives. Emergencies chapter covers the principles of immediate care in situations, such as hyperkalaemia and kidney stones. Integrated care chapter discusses strategies for the management of chronic conditions across primary and other care settings. Self-Assessment - 80 multiple choice questions clinical SBAs.

Dyslipidemia in chronic kidney disease is a common clinical problem and growing in prevalence. With the recent publication of clinical practice guidelines on the management of lipid related disorders in patients affected by chronic kidney disease, an up-to-date and comprehensive resource of evidence-based literature is needed. Dyslipidemias in Kidney Disease captures the growing body of information on this subject matter. This book presents the latest clinical evidence and management guidance for patients of various demographics and stages of chronic kidney disease. Written for the nephrologist community, as well as cardiologists and general practitioners, this guide will provide practical knowledge and fill a much needed void in the literature.

What regulation shall we have for the operation? Shall a man transfuse he knows not what. to correct he knows not what. God knows how (l)? Dr. Henry Stubbs Royal College of Physicians circa 1670 If dialysis therapy were a new phannaceutical product being evaluated by the FDA now, it might not be approved for marketing. The recommended dose, its potential toxicity, the side effects of under-or over-dialysis as well as its efficacy have been the subject of very few studies. The high mortality rate associated with the treatment may raise a few eyebrows. That it is a life-saving modality of treatment is undoubtedly true for more than 100,000 patients in the United States and for more than a million patients world wide. Because dialysis has extended the lives of many people by a variable period of time, most nephrologists have "rested on their laurels" and did not vigorously pursue studies to optimize these treatments. But facts have a way of intruding in all our lives and the facts are that the overall mortality rate of dialysis patients in the United States is rising and stands close to 25% per year and is closer to 33% per year for patients between the ages of 65 and 74 (2). These mortality figures are considerably higher for age-adjusted dialysis populations in Europe and particu larly in Japan, and certainly for the age-adjusted nonnal population."

Acute Renal Failure in Practice, edited by practising renal physicians, is the essential guide to the clinical management of patients with acute renal failure and its complex, life-threatening metabolic sequelae. This book explains the workings of the normal kidney, illustrates the aetiology and pathophysiology of acute renal disease, and provides practical treatment guidelines relevant to the day-to-day needs of the practising clinician. There is a clear emphasis on the underlying pathogenic mechanisms naturally leading to a full understanding of the rationale behind the recommended treatments. Each chapter is illustrated throughout by coloured tables and diagrams, and incorporates unique easy-to-follow "practice points" algorithms which detail, step-by-step, the precise treatment protocols required to succeed in caring for these complex patients. An entire section is dedicated to dealing with patients who develop acute renal failure in specific hospital settings, such as the labour ward or intensive care unit. Doctors working in a wide range of acute medical specialities frequently encounter patients with acute renal failure and will therefore find this an invaluable clinical handbook.

This thoughtful new book presents strategies for helping end-stage renal disease patients and their families deal with the psychosocial aspects of the chronic long-term illness. Technological advances in the treatment of this disease have offered much hope for improved quality in living which has led caregivers to have a greater concern for preserving the quality of life of their patients. In Psychosocial Aspects of End-Stage Renal Disease leaders in the field of many disciplines share knowledge and reveal problems that are still evident to them in the confrontation with this potentially fatal illness.Five comprehensive sections devote special attention to the different areas of concern for the psychosocial well-being of end-stage renal disease patients. The impact of renal disease on family relationships is covered by examining issues of family responses and coping measures such as marital and family reactions to home and hospital dialysis treatment. Ethical issues in treatment are explored, including the ethics of treatment refusal and a Jewish perspective on kidney transplants. Relations between staff and patients and a timely section on renal disease and special populations, particularly the elderly and AIDS patients, make up the final two sections of this informative volume. Professionals in all allied health disciplines will benefit from this important volume as it demonstrates a model approach, if not the definitive one, for the treatment of the psychosocial aspects of end-stage renal disease as well as other chronic illnesses.

The thrust here is for those who want to know more than the answer to an exam question - an approach to disease diagnosis and treatment which emphasizes thoughtful consideration of alternatives, finding ones way through uncertainties and lack of knowledge. The annual seminar on which this volume is based has evolved into a forum for open discussion of puzzling questions - actually old questions in the light of new data. To me, the adventure of life is in recognizing the openendedness of all things. So you thought that a certain disease was a settled question? In medicine a "settled" question is a transient conclusion. Even the solutions to the so-called simplest problems have another side. Our aim this year was to air out concepts and conclusions about hypertension, fluid-electrolytes, and tubulopathies. The stars were Drs. Juan Rodriguez-Soriano, Alan Gruskin, and Donald Potter, along with Drs. Gustavo Gordillo, Ronald Kallen, and Antonia Novello as guest faculty. Local stars included Drs. Mary Jane Jesse, Jacques Bourgoignie, and Carlos Vaamonde. Their contributions added to those of the other faculty and registrants, coalesced into vibrant exchanges which are reproduced here for the reader's perusal.

Ethical Problems in Dialysis and Transplantation presents an overview of issues with which nephrologists and decision makers are confronted in their daily practice. The search for a universal system of ethics and theories of justice are addressed. Furthermore the work provides a normative ethical discussion of ways of distributing resources with a view to selection and commercialization. Others chapters discuss a philosophical and religious analysis of stopping treatment and the clinical and ethical aspects of stopping treatment in dialysis. Different views from different countries on the subject of dialysis and transplantation are covered including the views expressed by contributors from India, Africa, Japan, Great Britain and China. The work presents the clinician with a guide to the ethical considerations underlying the treatment of dialysis and renal transplantation patients.

Aspects of cancer and cancer therapies; long-term adjustments of renal donors and recipients; community life (including support facilities and home dialysis); medical aspects of End Stage Renal Disease (ESRD); psychiatric disturbances; public policy issues; the role of the doctor, staff, and society, sexuality and loss of sexual function, surgical aspects; and anticipatory grief, acute grief, and bereavement are all discussed in this book for caregivers working with ESRD patients.